Paul Wyatt, Medicare Insurance Broker

Answer: The simple answer is 20% of the total charge after you have met your Part B deductible of $257 because Medicare is 80/20 insurance. The complicated answer is that each hospital/organization will charge different amounts based on the care you require in an emergency situation. I would never recommend staying on just Original Medicare because the 20% responsibility is uncapped and leaves a lot of personal financial exposure.

Answer: The best advice is to shop your plan once Annual Enrollment begins on October 15th. If you don't have an agent to assist you then I do recommend finding one in your area because they will usually have the best knowledge for specific situations such as that.

Answer: Many agents and organizations sponsor Medicare education events all year round. A Medicare 101 is a great way to learn about the basics of Medicare and what factors you should consider when choosing a plan.

Answer: If you still have employer coverage then you do not necessarily need Part B. However, it is best to sit down and compare your current plan to Medicare and see which would give you the best deal. Factors to consider in the comparison are premium, deductible, and max out of pocket. Once these figures are taken into account then you can make an educated decision on whether to continue employer coverage or to go fully onto Medicare.

Answer: It all comes down to the level of comfortability you have. Many people prefer having a local agent they can speak to and see for all of their questions and concerns about Medicare. Also, that agent will more than likely reach out to you yearly with any plan updates or changes for the next plan year. Not that there is anything wrong with a virtual agent but many times they may not know the local area and how plans work near you with the local physicians and pharmacies. This can be especially true when it comes to Medicare Advantage plans. When it comes to agents in general I would recommend finding a broker, no matter if that is a local or virtual agent, to assist you because they will be able to compare plans across multiple carriers. When you contact a specific carrier they will only be able to compare the specific plans they offer and you may miss out on a better plan.

Answer: Many times the plan is not explained to them and they do not fully understand what they are agreeing to. When the presence of so many call centers and aggressive marketing techniques it seems many feel duped into a plan they can't fully use. I always recommend finding a local agent that you can trust and speak to when discussing your options. There is no perfect answer when it comes to choosing a Medicare plan because everyone is different and has varying health needs. Advantage plans can be a great option but they are not for everyone and not every plan is created equally. If this is an option you are considering then I would recommend sitting down with an experienced individual to discuss if it is the right option for you.

Answer: Absolutely! Medicare A&B covers preventative services like the shingles vaccine as well as many others like flu, pneumonia, covid-19, and many others.

Answer: The best way to find out is by contacting your local social security office and asking if you fall into the IRMAA bracket. IRMAA is an additional surcharge added to your Part B and D premiums if your income exceeds the government set thresholds. According to the limitations it classifies you as a high income earner in retirement. The brackets are based on your adjusted gross income from the previous 2 years. For 2026 IRMAA, your 2024 tax return is used. There is a chart available with the income brackets linked to each surcharge you may receive. You can access this chart by contacting the social security office or by searching IRMAA bracket online.

Answer: You should be shopping your drug plan every year during Annual enrollment by comparing all plans available in your area. Also, many plans have better copays associated with different pharmacies. Many times it helps to compare different pharmacies available to you as well as shopping your plan.

Answer: Figure out what is most important to YOU when it comes to your health plan. There are a lot of factors to consider when looking at your options but the most important thing at the end of the day is you.

Answer: If they miss an enrollment window and do not have qualifying creditable coverage as good as Medicare then they will have a penalty imposed upon them. For example, if an individual has started Original Medicare (A&B) but they decline Part D (prescription drug) and they have no other insurance then they will begin to accrue a penalty until they pick up a Part D drug plan. This penalty continues to accrue every month they go without coverage. Once they do pick up Part D then a penalty will be assessed for every month they went without and they will continue paying said penalty for their lifetime.

Answer: That is a very complicated question to answer. In order to explain or understand the difference more information is needed. Yes, plans are different based on zip codes but it would also be based on the type of plan they have as well.

Answer: Yes, they are covered under Part A and Part B. However, they will likely only be covered at 80% because Original Medicare is 80/20 insurance. You will typically pay coinsurance or a deductible when seeking these services with only Original Medicare.